"That is happiness; to be disolved into something complete and great. When it comes to one, it comes as naturally as sleep." - Willa Cather

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Wednesday, 29 June 2011

35 weeks + 4 - visit with the midwife

I suppose I had better write a post before my life of responsibility begins again. Since the departure of my family, my days have consisted of exercising in the morning, working in the afternoon and Skyping and reading at night. True it has felt like an empty life, in comparison to what I am used to, but it wasn't at all boring or unhappy(of course, key to the "not unhappy" was knowing I wouldn't be alone for long). Perhaps the best part was the tv was not turned on for a second. I abhor television (as much as I abhor candy). That is probably the reason I never talk about it. Until I moved in with SR, I had gone my entire adult life without a tv. The fact that one even sits in our apartment is annoying to me, but when you live with other people, their happiness tends to count for something, too.

This morning was typical in that I exercised from 8am to 12:30. There was also a shower in there (before and after the pool) plus socializing, etc. Sound excessive? Well, I guess it would be if I had other responsibilities. But family on another continent + maternity leave = lots of time to do what I want. This morning it was

(this was a relative rest day since none of it was strenuous. And no, I don't precisely plan out these times ahead of time, I just sort of went with the feeling)

Then I finally had to stop to get to my midwife appointment at 1pm.

Appointment Summary

I actually weighed myself beforehand since they don't weigh you here - not even once have I been weighed at an appointment here and I am officially just over 62 kgs now! I thought it was a fluke the last time I weighed myself, but no I am that heavy. So that's a just over 8kg weight gain and I hope this is where I stop - really, he is big enough and so am I.

Blood pressure: well, I was hoping it would be low since blood pressure is always lower right after exercise (unless you're like gushing out blood from an injury or in rhabdo, etc), but it was 108/56. I was a bit disappointed because I always like my health practitioners to think I'm on the verge of fainting. (as an aside, I have one time in my adult non-pregnant life weighed over 130 lbs and at that time my systolic blood pressure was over 130, so I took it as a sign today that I shouldn't gain any more weight. Ie. the higher my blood pressure the closer I am to weighing too much. OCD? Yes.)

Baby's pulse: 130. Dang. I liked it better when it was low, but he seemed quite bothered by the fact that she was fidgeting with him and he was kicking and moving like crazy so I won't obsess about it. Or will I?

Baby's position: head "very deep down" in pelvis. She said he was completely "locked in" now and that nothing anyone could do would turn him. I asked her what she thought it was like to be doing a headstand in a bony pelvis (albeit in water) 24/7. She laughed as if she had never considered it. Of course he must like it, in a way, but I must admit I think about what it must be like all of the time and it just doesn't sound pleasant. Please come out soon baby, then you can sit upright on me and eat my boob.

Fundus measurement: 28 cm. She said "I would automatically have to refer you to a scan now if you hadn't just had one because you're 2-3 cm below the curve". Well, there you have it: Denmark does not systematically ignore small measurements after all!

Internal exam? Nope. They don't do that anymore. The midwife explained it has apparently no predictive value. Plus, "it is unpleasant". I was like, "I find them very pleasant" and winked at her. Okay, I didn't really. Are internal exams still done in the US before labor begins? I remember getting one at 38 weeks with The Lorax.

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These last two days, while nice for me, have been shadowed by the fact that SR is going through a lot. And I feel terrible about it. He said good-bye to Natti for 3 months. Can any of you moms imagine being away from your child for 3 months? I just don't think I could live without The Lorax for 3 months. And for SR, it is no easier. Every time period he lives without Natti, a little part of him dies; the part that should have been experiencing the world with her, but isn''t. And neither The Lorax nor I nor a new baby can substitute for this feeling of loss.

I keep thinking about the fact that SR went to a movie about penguins with Natti and Andreas and that he cried at the end. When even penguins can become a metaphor for how sad your life is, things are really rough.

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But on Sunday (already) we are leaving for a week's trip to Sweden. That is SR, The Lorax and I, together with SR's extended family. I am going to soak up this time with SR and The Lorax as never before.

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Finally, I owe you all at least one running song, and this time it is "Guess I lied" by The Qualia.

While musically it is a great song for running, I was extremely impressed with it because I thought the lyrics were about an incestuous relationship between a brother and a sister. No, I don't condone that kind of relationship - but I just kept thinking "Can you SING that?? In a song??". Now, despite having been an English and French literature double major in college, I am terrible at interpreting poetry. I tend to read tons of things into poems or songs that aren't there. Or just miss the point entirely. This song was no exception because the band says on their website that it is about a brother and a sister "sharing a joint". Well, that basically ruined the song for me. But I still like running to it.

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Fun facts (now, in times of uncertainty, such as now with SR & Natti, I tend to turn to exercise and weight loss to make me feel in control. No secret there. So I thought I'd share with you a little tidbit I read from the June 23rd New England Journal of Medicine)

19 comments:

"I was a bit disappointed because I always like my health practitioners to think I'm on the verge of fainting" - ha! You totally crack me up, love it. So sorry to hear what SR is going through, that sounds very rough. But, I guess the pending newborn will help distract him! You are an exercise machine I must say - but if you have a nice gym and time to spare I can see how maybe 3.5hrs of movement and socialising could be appealing (hey if we do outdoors running or hiking why not indoors right?)...

Yes, they do internals in the US still. I have mine tomorrow morning, as a matter of fact (35 weeks). Not going to put much into the information I get from that exam except that I want to go to the beach with my family next week and was told if I am dilated >2, I can't go. Hurumph.

My kiddo's fetal HR has never been lower than 150 and I don't get why you'd want yours to be low? What's the diff? Seems like an arbitrary number to me and kind of an odd thing to obsess about.

Sorry to hear SR is going through a hard time and no, I cannot imagine being away from Baker that long!!!

Cherelli- have to say the idea of biking and running for that long at a gym does not sound too appealing to me! It was all outdoors except the swimming, which would normally have been in the ocean, but it was too windy yesterday. One of the reasons I'm at the gym for only short times is what they call air conditioning doesn't really seem to function so it is extremely hot in there!

The Chapples,

Can't go to the beach if dilated, but women can give birth in water? I'm confused why you can't go to the beach.

As for the heart rate - you are right - it doesn't really matter. But I look at it like a rest heart rate in adults, I guess. If you can function on a very low heart rate, it must mean your heart is strong (you have a high stroke volume). But a high heart rate does not mean a baby is unhealthy. It just depends on when you measure it. It is also just a sign that the baby is reactive.

But if during labor, the baby's heart rate goes down with contractions it can be a sign the baby is not getting enough blood an in distress - so a low heart rate isn't always a good thing! I, of course, don't know all the details of fetal physiology and shouldn't go around acting like I do.

I wouldn`t monitor my weight those last few weeks, especially in a "summer pregnancy". There definitely is some water weight involved which causes some more gain as well as fluctuations. You are going to pee it ous once your baby is there :-). As you have posted a lot on weight gain and have definitely thought about the issue I would like to ask you a question: Do you think the weight part of the pregnancy weight gain that is not water (which is obviously calorie-free) is caused by an increase of calories/decrease of activity or that hormones cause weight gain/fat gain regardless of how you eat? My experience was that I lost weight in the first trimester though I didn`t change calorie intake (I think I didn`t, I don´t count) which was weird for I lost those 5 had tried to lose for months before without trying when pregnant. I gained back the weight between week 16and 20 without increasing my calories and "real" weight gain started at 20 weeks. Again I am clueless if I am wrong about my calorie intake, I definitely decreased exercise volume as my pregnancy progressed but I wonder what happens as a woman doesn`t change a thing...Also, i have found that the increase in calories of 300/day is most definitely an over-estimation as the fat-free mass that is part of the fetus, uterine muscle and placenta require less calories than fatty tissue...Just curious what you think!

I think the "can't go to the beach if dilated" thing is more about liability on the part of my OB practice. I will be over 4 hours from home and I think they just have to warn people at the end of pregnancy not to travel too far lest they go into labor - has nothing to do with me actually being at the beach. The truth is, while I don't really WANT to give birth in another state in a hospital I don't know, it wouldn't be the end of the world. Like I said, I think it's more of a legal kind of thing - I mean, imagine they didn't warn people and someone went off on some trip, had some miserable birth experience elsewhere and then came back and blamed their OB for not warning them not to travel? I mean, seems like common sense to me that there's always a change at this point that labor could start but I can just seem some dumbass trying to blame their doctor somehow if something went wrong. My hunch is that even if I AM dilated, I am going to the beach anyway (rebel!!)...there are two great hospitals near where my parents' house is and I can't imagine I am going to actually go into labor 4 weeks early. I'll pack a hospital bag and bring the carseat just in case though. I don't want to have to buy a carseat down there.

Yes, they still do internals in the US. Although unpleasant, I am so glad they did. Despite my suspicions, she thought baby was head down right up until the moment she did the internal. Running is over as they don't want labor to be induced until baby flips on his/her own or by ECV next week. Fingers crossed! They don't attempt to do vaginal breech deliveries in the US anymore no matter what the position. Apparently doctors aren't trained in how to do them in medical school anymore, they just opt for the c-section immediately.

Anon - weight gain in pregnancy is very complicated and I am no expert. Fluid retention of course is an example of non-calorie dependent weight gain. But overweight women can actually lose weight while pregnant while underweight women tend to gain more. But I think our hunger signals are well-tuned to how much an individual needs to gain. Though, not always, as some women gain WAY too much and some not enough. But I think a combination of a healthy diet (ie really low on sweets and saturated fats) and exercise will land a woman just about where she needs to be. And the point at which women retain water is different for different women. I had pitting edema in my legs from week 20 or so on! But it hasn't really increased at all.

Yes, The Chapples, I realized as I walked out the door this morning that that was probably what you meant and not the actual swimming part. Yeah, I'm going to Sweden which is a 6 hour drive from our town and I admit it is a chance, but, yeah, I bet they can figure things out in Sweden, too, if I go into labor there. It's really just a question of how much the hospital you deliver in matters, I guess. The reason I didn't go to the US, was I couldn't stand the thought of going into labor on the plane!

Sarah, interesting they don't want you to run. I always figured running pounded that head into place- but I have NO CLUE what I'm talking about, so don't take it as a recommendation. Also interesting that you had a suspicioun the head was not down. I also think I would know immediately if his head turned up, but I'm not 100% certain of that. They will, by the way, to an exam once I go into labor. Though avoidance of an emergency c-section is a good thing!

Yeah, doctors used to be really good at using forceps to get babies out. It is a cool art that I have witnessed done by an older obstetrician. He was known for being able to get any baby out in any position and keeping them alive - and I really think it was true. There have just been so many law suits in the US involving forceps that they have become a thing of the past. Sad in a way because, if used right, most c-sections could be avoided.

Sarah - that is misinformation about breech birth. There are in fact many Dr's that are still trained in vaginal breech birth and that will deliver a breech baby in a low-risk pregnancy. My first baby was breech and was able to be turned via ECV at 39 weeks, however, if she had not I would have had the option of a qualified OB who would have delivered her. I am currently 27 weeks pregnant and should this baby be breech, I am pleased to have this option again. There are also a number of midwives (both CNM and direct entry) who are qualified and willing to deliver breech babies. It is just a matter of becoming informed!

SLG - I wish you the best in the final weeks of your pregnancy! Can't wait to see the update when your newest son is born.

Now that Doritos is discontinuing my favorite flavors, I'm going to shrink to nothing.

No subject has been left untouched by popular music. "Timothy" by the Bouys became a hit because people didn't listen to the lyrics; it's about cannibalism! My favorite happy dance band, the Housemartins, had songs about the violent overthrow of the British monarchy.. but they were just so darn catchy no one cared.

TV and candy are a large part of my training regimen (I made fudge yesterday to bring to Afton). Then again, I eschew personal relationships, so I have time for TV.

Shannon in KS - interesting info! I wasn't sure what the status was in terms of breech delivery in the US (not sure in Denmark either). All the best to you, too in your pregnancy! I will keep my fingers crossed you don't have to go through ECV again (believe it or not I got to attempt it on a woman while I was a medical student and it wasn't fun (or successful) for either of us, but good thing there was someone there with more experience. Anyway, it did NOT look like fun.

Steve, it only took me an hour to figure out what you meant with that dorito comment - but aren't they corn chips and not potato chips?? They surely can't contribute to weight gain :).

And just to set the record straight, I don't consider chocolate candy. I consider it chocolate. Same goes for fudge. Fudge is chocolate. Candy is like Mike-n-Ikes and Smartees. I happen to live with someone, though, who also considers candy and tv an integral part of his training.

yes, they still do internals here in the US, though you can almost always decline them. most women just don't know that.

also, most midwives don't do them. Mine doesn't.

My view is that if they are not predictive whatsoever, then what is the goddamn point? And why would I let some do it? Some say not doing them also lessens risk of infection (by not inserting any foreign object, including a gloved finger), but I was less worried about infection than I was motivated by not doing unnecessary, non-predictive "checks" that are, um, not exactly pleasant!

your view of low vs. high BP differs from mine. I guess mine has been close to yours, but I would've considered it on the low side whereas you sounded disappointed that it was not low? But I am not a doctor - I have no idea.

yes, they still do internals here in the US, though you can almost always decline them. most women just don't know that.

also, most midwives don't do them. Mine doesn't.

My view is that if they are not predictive whatsoever, then what is the goddamn point? And why would I let some do it? Some say not doing them also lessens risk of infection (by not inserting any foreign object, including a gloved finger), but I was less worried about infection than I was motivated by not doing unnecessary, non-predictive "checks" that are, um, not exactly pleasant!

your view of low vs. high BP differs from mine. I guess mine has been close to yours, but I would've considered it on the low side whereas you sounded disappointed that it was not low? But I am not a doctor - I have no idea.

1. regarding the internal exams, I have not seen the study my midwife was referring to, so I really can't comment on it - other than to say it is never necessary to do one unless one is monitoring the progress of active labor. Or if one suspects premature labor or cervical incompetence (but those would be suspected much earlier in pregnancy than the 35-40 weeks where internal exams are typically done in the US). I have also heard there is a risk of infection from having an internal exam, but again have never seen the study/studies.

2. Blood pressure is however something I feel I know more about. It is a common misconception among health care workers that a low blood pressure is dangerous. Unless one has heart failure or some sort of systemic shock, the lower the blood pressure, generally the better. As a physician I would not worry about a low blood pressure in an athlete or a thin person unless the person is having symptoms (like diziness). It is generally expected that a lean athlete would have a systolic blood pressure between 85 and 115, I would say. How exactly blood pressure changes in pregnancy is not something I am an expert in, but again, a lower blood pressure is something I would only take as a good sign. And higher blood pressures can be a sign of serious problems.

Hello from Rude Skov

Photo by Stine Sophie Winckel

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My name is Tracy. I am a physician scientist from the USA, living with my husband and two young boys in Denmark. I work as a post-doc fellow at Næstved Hospital. I have a scientific interest in vision loss, vision loss during exercise, exercise, running during pregnancy, MAF training as well as nutrition and health for athletes. I also have a love for music, physics, statistics, cycling, yoga, cross-country skiing, bla bla bal.

I was a member of Team USA at the IAU World Championships in Ultra Trail Running in 2013 in Wales. I am now training to run with Team Denmark at the IAU World Championships in Annency, France in May 2015.